ASAPS Annual Meetings

San Francisco, CA (April 26, 2014) — A panel of plastic surgeons at the annual Aesthetic Meeting in San Francisco of the American Society for Aesthetic Plastic Surgery (ASAPS), today presented a variety of measures and methodologies to better gauge patient outcomes and satisfaction in a more objective manner than ever before realized. In an effort to steer-clear of opinion or subjective evaluations, plastic surgeons have come together to identify practical and logical means to evaluate the more objective results of various facial rejuvenation procedures.

“It almost goes without saying that beauty, being in the eye of the beholder, has always been a matter of preference and opinion,” states Al Aly, MD. “But as a group of surgeons who strive to achieve optimal results and continually search to improve patient outcomes and satisfaction, we had to ask ourselves why we couldn’t come up with some means of measuring the results of facial rejuvenation procedures objectively,” he continued.

The doctors have examined patient satisfaction in a fairly simple manner for years -- Is the patient happy with their results, or not? Is the surgeon happy with what they were able to provide to their patient and were they happy with their own results? While all of this information is important, it is entirely subjective and the bigger question remains: Can surgeons evaluate their results based on more objective measures of attractiveness?

When you factor in personal preference and perception you create another obstacle in terms of finding a less subjective means to evaluating outcomes. Not every plastic surgeon would agree on other surgeon’s results. One might find something attractive whereas another would feel they could’ve done a better job – so who is to say? Both surgeons could recognize change – but determining whether it is positive change is another issue.

This raises the question of how humans determine attractiveness. Until recently, plastic surgeons had very little information on this subject and have looked to evolutionary psychology as guidance. Plastic surgeons have discovered that humans are, for the most part, Koinophiles. Koinophilia, a term first used by biologist Johan Koeslag, refers to sexual creatures who, when seeking a mate, have a preference for those who do not have any unusual, peculiar or deviant features. In essence, humans, as sexual creatures prefer the common – the average. That is, for them, what defines attractiveness. When you examine the specific physical facial characteristics of certain individuals and evaluate the distance between someone’s eyes or their lip-to-nose ratio for example, you will find that those who the majority of people deem attractive fall into the middle in terms of measurements.

Further, we are all what can be classified as cognitive averagers. We, on a daily basis, take in other people’s faces. We see them on television, in the street, at work – and what we haven’t fully recognized is that our brains are wired to constantly re-assess our perception of beauty based on the overall average of what we see every day. “This is among the reasons why fashions change and trends change. It is the work of our cumulative cognitive averaging that ultimately creates the next definition of attractiveness. It is ever-changing, but it is almost always based on averaging,” explained Dr. Aly.

Dr. Aly has been examining his own patients and their results for quite some time and has discovered that while there may be an obvious difference between pre-and post-op, change didn’t always necessarily translate to improvement. This in and of itself requires doctors to carefully consider what is perceived as ‘normal’ on average and therefore most attractive. Are doctors merely creating change, or are they creating what can be defined, (either subjectively or objectively), as attractive?

The panelists agree. There is clearly a paradigm shift taking place respecting how to evaluate patient outcomes in facial rejuvenation.

James Grotting, MD, has been utilizing a new tool in his own practice to assess the outcomes of facial aesthetic surgery, in an effort to continually improve what he is doing and the results both he and his patients see. Andrea Pusic, MD, Associate Professor at Cornell University created a questionnaire/survey tool, the “Face-Q”, to enable surgeons to better understand the impact facial aesthetic treatments may have on a patient’s quality of life. To date, more than 1,000 Face-Q questionnaires have been completed, and Face-Q is available to any surgeons who wish to use it.

Dr. Grotting today presented his findings from the results of a 250-facelift patient satisfaction survey along with a study of nearly 50 of his patients utilizing the Face-Q survey. Findings revealed that patients are not only satisfied, but that their quality of life improves. A patient’s social confidence and psychological well-being improves post-op, including the manners by which they interact with the world and how they feel about themselves. Grotting asked his own patients who participated how much younger they felt they looked and how long they felt their results lasted, one year post-op.

“The Face-Q is a welcome addition to my practice,” explained Dr. Grotting. “It is targeted and the questions are relevant to particular patients, procedures and surgeons and can be used by researchers and clinicians. It is a benefit and a service to the plastic surgery community,” he continued. “From using Dr. Pusic’s tool, I have learned things about my own procedures that I would not necessarily have noticed otherwise. I have learned things about my patients including their social function and how they feel in relationships with friends and family – all of which are tied into their surgical outcomes,” Grotting explained.

Foad Nahai, MD, moderator of the panel explained, “We have always felt that objective evaluation was probably an elusive goal and that ultimately, success was measured by the patient - but now there are measures to determine if a procedure met the patient’s expectations. Did it change their outlook? Did it change the areas they were concerned about? As the subspecialty of aesthetic plastic surgery evolves, we are developing key analyses and tools to improve outcomes in novel ways.”